The legislative session isn’t really over until the Governor either signs or vetoes the bills sent to him. In Iowa, the Governor has 30 days from the time session ends to make these decisions. The Governor finished his work with a couple of days to spare, approving a budget that increases spending by 3% but making several vetoes that may significantly impact services to Iowans with disabilities.
While the Governor held a bill signing ceremony to celebrate the historic compromise that will give more than 150,000 Iowans access to free or low cost health insurance, he quietly used his veto authority on the same bill to cut out funds intended to protect services to Iowans with disabilities as the redesign enters its second transitional year.
The Governor vetoed:
To compound the issue, the Governor signed language that requires counties to pay back any savings they get in their MH/DS systems because people are now eligible for the newly created Iowa Health and Wellness Plan.
So while the Governor signed $29.8 million in funding for non-Medicaid regionally delivered services to people with disabilities, he cut over $22 million in funds that would have stabilized services to Iowans with disabilities, and some of that $29.8 million will need to be repaid to the state next year.
In addition, three counties (Polk, Clinton, Scott) that have about $2 million in unspent risk pool funds must return those funds to the state, and counties that have outstanding Medicaid bills are required to use their remaining local dollars to repay those funds by June 30, 2014. Any one of these vetoes could have resulted in some setbacks in the redesign of the mental health and disability services system, but the combination of these cuts could threaten the stability of the entire MH/DS system.
You can read the Govenror's veto message on the waiver waiting list here, and on the risk pool here.
Concerned? Wondering what you can do? Unfortunately, these changes are now law and your legislators can’t fix things until the session starts up again in January. But they can start working on a solution now. Talk to your legislators. They are back home now, in their districts, back at their “regular” jobs. Call them and ask them what they can do to fix this situation (and ask what you can do). Click here to find out who represents you at the Iowa Capitol, and how you can reach them this summer.
|
Legislative Action |
Final Action (Governor) |
Per Capita Equalization (funds to 54 counties) |
$29.8 million |
$29.8 million |
Risk Pool (priority to 45 counties) |
$13 million |
$0 |
Funding to reduce Medicaid waiver waiting lists |
$8.7 million |
$0 |
State funding for Mental Health Advocates |
$250,000 |
$0 |
Standardizing Mental Health Advocates |
Yes |
No |
Protecting State Payment Program from federal cuts |
Yes |
No |
Allowing non-contiguous counties to join regions |
Yes |
Yes |
Requiring evidence based practices in regions |
Yes |
Yes |
Grandfather in non-target populations currently served |
Yes |
Yes |
Requires counties to repay 80% health care reform ‘savings’ from per capita equalization funds received or by lowering levies in that amount (or combination). |
Yes |
Yes |
Requires counties that didn't spend all of their risk pool funds to repay them (Polk, Scott, Clinton will owe a total of $2 million). |
Yes |
Yes |
Requires counties that were holding their Medicaid bills to work out a payment plan so the debt is paid off by June 30, 2014. |
Yes |
Yes |
Counties would calculate how much money they save in local mental health and disability services dollars because a person that previously received locally funded services is now getting those services paid for by the Iowa Health and Wellness Program. At the end of the year, the county would have to repay 80% of those savings (called the “offset”). They are to repay this using their equalization funds. If they didn’t receive equalization funds, the county must lower its property tax levy by the amount of this “offset.” If the county’s savings is more than its equalization dollars, the county must repay the funds and lower its levy.
There were several legislators that were not comfortable with this requirement – so they asked for a Medicaid Offset Study Committee to review the impact of the offset and determine what this will do to the newly forming regions’ ability to make progress on meeting the new core services requirements. This committee will be assigned on July 18, when the Legislative Studies Committee meets and determines which interim committees will meet and who will serve on them. Watch the website (www.infonetiowa.org) for more on this.
As mentioned before, the Governor signed into law the Iowa Health and Wellness Program that was adopted by the Legislature in the final days of the legislative session. This carefully crafted compromise gives low-income Iowans access to health insurance by:
Both parts of the Iowa Health and Wellness Plan will require federal approval. To get federal approval, the state must file two state plan amendments for the Medicaid expansion portion of the program (to create the new eligibility group and to create a separate benefits package) and two demonstration waivers (one that allows waivers from certain Medicaid requirements, and another allowing federal dollars to be used to purchase private insurance plans).
The Iowa Medicaid Enterprise is busily writing these plans and waivers, and will have them available for public comment later this month. They plan to host public hearings around the state on July 21-23 (but details on these meetings are not yet available). They will take public comment at the meetings, but comments can also be submitted by email or mail. Iowa Medicaid plans to submit the waivers and state plan amendments on August 19. As part of the application process, the Iowa Medicaid Enterprise must show how they addressed issues brought up by the public. After the plans are submitted, the Federal government will also have a public comment period.
The state has to be ready to go when enrollment begins on October 1. Iowans have only until March 2014 to sign up for this new coverage, so you can see that things will move very quickly. While we can’t tell you much more now, we will continue to provide updates on our website (www.infonetiowa.org) and on Facebook, or watch for more details here.
What to know what other appropriations and bills were signed into law? Here are a few options: